The biggest disparity among Pennsylvania women with and without health insurance was found regarding access to Pap smears and mammograms. (Uninsured patient via Shutterstock)

A new report published by the National Women’s Law Center (NWLC) looks at how low-income women living in states that expanded Medicaid access health care in comparison to women living in states that rejected expansion.

Pennsylvania is one of the 25 states to reject expansion offered in the Affordable Care Act, which incentivized states to expand Medicaid by offering to provide 100 percent of the cost to cover the new population in the first three years, and no less than 90 percent in later years.

Instead, the state’s Republican Gov. Tom Corbett has proposed a program called Healthy PA. The proposal has been criticized for slashing benefits to current Medicaid enrollees and containing conditional provisions—such as premiums for applicants earning less than 100 percent of the federal poverty line—similar to those already rejected by federal officials in response to plans proposed by other states.

Even if amended, the earliest implementation date for Healthy PA is January 2015. Meanwhile, approximately 281,000 uninsured adults living in Pennsylvania—20 percent of the uninsured population—are stuck in the “coverage gap”: They earn too much to qualify for traditional Medicaid, but not enough to earn tax subsidies to help purchase a private plan through the state exchange. The NWLC report looked at the 179,000 adult women stuck in the gap in the state.

In the big picture, the analysis found that low-income women without health insurance are less likely to access basic health-care services, including preventive care. From the report:

For example, uninsured low-income women received colonoscopies, which can not only detect, but in some cases prevent colon cancer, at a rate nearly 70 percent lower than insured low-income women. The rate of cervical cancer screenings, which have been shown to significantly reduce the incidence of cervical cancer and mortality over time, was nearly 25 percent lower for uninsured low-income women than for insured low-income women, and the rate of mammograms was nearly 60 percent lower.

The biggest disparity among Pennsylvania women with and without health insurance was found regarding access to Pap smears and mammograms.

According to the report, only 59.6 percent of low-income women over the age of 18 in Pennsylvania without health insurance had a Pap test in the last three years, compared to 81 percent of low-income women in that same age bracket with health insurance. Similarly, 43.7 percent of women over the age of 40 without insurance had mammograms, while 75 percent of women in that same age bracket with insurance did have mammograms.

Pennsylvania offers a Healthy Woman program, which offers free breast exams and Pap smears to uninsured low-income women over the age of 39 without symptoms, and those 39 and under if symptomatic. The disparities indicate that many eligible women are not aware of their services.